GI articles
From Wednesday Dec 01 2021 to Wednesday Dec 22 2021
This issue includes 226 articles. Please be mindful of the authors and publishers copyright while sharing the content.
Guidelines
| Endoscopy |
Histopathology is used as the gold standard. Level of agreement 100 %. CONCLUSION : The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps. |
Meta-analysis
meta-analyses and systematic reviews
| Aliment Pharmacol Ther |
G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy. |
Systematic review with meta-analysis: COVID-19 outcomes in patients receiving anti-TNF treatments. TNF-α inhibitors are associated with a lower probability of hospitalisation and severe COVID-19 when compared to any other treatment for an underlying inflammatory disease. |
In patients with CD refractory to anti-TNF, ustekinumab and vedolizumab are similarly effective in induction, but as maintenance treatment, ustekinumab appears to be more effective than vedolizumab. |
HBsAg loss is associated with a reduced risk of clinical outcomes. However, several shortcomings in the published studies prevent a more definitive conclusion on the potential benefits of HBsAg loss. |
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
2019 global NAFLD prevalence - A systematic review and meta-analysis. Despite regional variation, the global prevalence of NAFLD is increasing overall. Policy makers must work towards reversing the current trends by increasing awareness of NAFLD and promoting healthy lifestyle environments. |
There were stark differences in the prevalence and risk factors between MAFLD and NAFLD. However, in the use of the MAFLD definition, a greater emphasis on the management of concomitant metabolic diseases and a collaborative effort is required to explore the complex pathophysiologic mechanisms underlying the disease. |
| Gastrointest Endosc |
Open access
2articles are open access at time of publication, full text is typically available in PMC (link provided). Moreover, many of the guidelines, editorials and case reports are also open access through the provided publisher link.
Studies
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
Addressing the challenge of NAFLD will require a re-envisioning of the liver health landscape, with greater focus on joined-up systems thinking and action. This new framework can help guide this process, including by outlining the stakeholders with whom the liver health community needs to engage. |
Alcohol consumption and risk of inflammatory bowel disease among three prospective US cohorts. This prospective study did not identify a relationship between overall alcohol consumption and risk of CD or UC. Our suggestive associations between alcohol types and risk of CD and UC deserve additional investigation. |
Rapid HCV treatment scale-up to PWID in community settings, whilst maintaining high SVR, is achievable. However, other interventions are required to minimise re-infection; reduce drug-related deaths; and improve post-SVR follow-up testing regionally. |
Tofacitinib demonstrated consistent safety up to 7.0 years. Data collected up to Month 36 support long-term efficacy beyond the 52-week maintenance study. |
In this US population-based study, skipping breakfast was associated with a high risk of cardiovascular mortality in MAFLD but not MAFLD-free individuals. |
Persistence rates for first-line biologicals among IBD patients were low and one-third switched treatment. Surgery rates and direct costs decreased over time, but whether this is related to the use of biologicals has yet to be determined. |
| Am J Gastroenterol |
Patients with SPS and their FDRs have an increased CRC risk, confirming other reports. Interestingly, patients with SSL were noted to have an increased risk of prostate cancer. Relatives of individuals with both sporadic SSL and adenomas, irrespective of size or dysplasia on examination, may have an elevated CRC risk, suggesting closer colonoscopy surveillance in this population. |
Abstract The burden of diarrheal infections globally, including the chronic health consequences, is an important problem. Herein we describe a recent paper published by the Journal and describe how it fits within and advances our knowledge in this area. |
| Clin Gastroenterol Hepatol |
Abdomino-anal Dyscoordination in Defecatory Disorders. Higher PC3 scores were associated with low rectal and high anal pressures at rest and during evacuation, thinner external oblique, and thicker internal oblique muscle during evacuation. A greater PC3 score was associated with increased odds for DD versus health (OR[95% CI]=2[1.1-3.6]), and separately versus constipation with a normal BET (OR[95% CI]=3[1.6-5.7]). Taken together, these findings reveal three, possibly interrelated, disturbances suggestive of dyscoordination in DD: aberrant activation of abdominal muscles during squeeze in DD, dyscoordination of the abdominal muscles during various tasks in constipated women, and abdomino-anal dyscoordination. |
Collagenous Gastritis: Characteristics and Response to Topical Budesonide. Adults and children with CG have a wide variety of symptoms, and, notably, topically targeted budesonide therapy produced clinical and histologic improvement after other therapy had failed. |
A 12-week entecavir is suggested to co-administer with DAA for HCV/HBV dually infected patients. |
There is greater impact on bowel and somatic symptoms and quality of life in IBS-D with BAD compared to IBS-D without BAD. Screening for BAD in IBS-D is especially relevant with more severe and frequent diarrhea along with urgency. |
NAFLD and associated fibrosis are highly prevalent in children and adolescents with severe obesity. An intensive multidisciplinary lifestyle management program which causes significant weight loss not only improves liver steatosis, but also fibrosis. |
Anxiety and depression were greater in the standard-care than multi-disciplinary clinic (12 vs 10, P=0·19) and quality of life lower in standard-care than the multi-disciplinary clinic (0.75 vs 0.77, P=0·03). An incremental cost-effectivness ratio found that for every additional $3555AUD spent in the multidisciplinary clinic a further quality adjusted life year was gained. Twelve months after the completion of treatment, integrated multidisciplinary clinical care achieved a greater proportion of patients with improvement of symptoms, psychological state, quality of life and cost, compared with gastroenterologist-only care. |
Meet EBE: The Development of an Evidence-Based Endoscopy Simulator. Surveys indicated the product was viewed favorably by participants, and there is a strong desire for this type of educational product. The EBE simulator is a unique, desirable, and effective educational platform based on evidence-based medicine principles that fills a gap in available tools for endoscopy education. Further studies are needed to assess whether EBE can aid in the long-term knowledge retention and increase adherence to guideline recommendations. |
Both clinical-related and treatment-related components were significantly associated with persistent inflammation. Definitions based on CRP>3, FC>150, FC>350, double biomarkers (FC>250 &/or CRP>3) or more visits did not improve predictive ability. Persistent inflammation, defined simply and readily by FC>250 over two consecutive visits, was associated with a significantly higher risk and shorter time-to-occurrence of a composite outcome reflecting disease progression in asymptomatic infliximab-treated CD patients. |
| Endoscopy |
CONCLUSION : The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports. |
| Gastroenterology |
LS carriers show elevated mucosal T cell infiltration even in the absence of cancer. The normal mucosa immune profile may be a temporary or permanent tumor risk modifier in LS carriers. |
The origin and contribution of cancer-associated fibroblasts in colorectal carcinogenesis. In colorectal carcinogenesis, pericryptal Lepr-lineage cells proliferate to generate MCAM + CAFs that shape the tumor-promoting immune microenvironment. Preventing the expansion/differentiation of Lepr-lineage CAFs or inhibiting MCAM activity could be effective therapeutic approaches for CRC. |
| Gastrointest Endosc |
A novel classification for adverse events in gastrointestinal endoscopy: the AGREE classification. The AGREE classification provides a standardized and reproducible approach to the assessment of AEs in diagnostic and therapeutic gastrointestinal endoscopy. Broad implementation of the AGREE classification may facilitate the evaluation of AEs across different endoscopists, disciplines, endoscopy services and regions. This standardization of AE reporting will support improved quality assurance in gastrointestinal endoscopy. |
Artificial intelligence for assessment of bowel preparation. In test set 2, sensitivity for inadequate bowel preparation for each segment was 100% and agreement between raters and AI was 68.9% to 89.7%. Agreement between raters alone versus raters and AI were similar (kappa 0.694 and 0.649, respectively). The algorithm assessment of bowel cleanliness as measured with the BBPS showed good performance and agreement with experts including full withdrawal colonoscopies. |
Moreover, after controling for potential confounders, siblings aged 60 and above were significantly less likely to respond (aOR, 0.3; 95% CI, 0.1-0.7; p <0.01). CRC patients are willing advocates of screening, and siblings contacted by patients from the intervention group were also more likely to reach out to the study team. However, overall sibling response rates were low despite advocacy, suggesting that patient-led advocacy should at best be used as adjunct to other, multipronged CRC screening promotion modalities. |
Impact of colonoscopy on working productivity: a prospective multicenter observational study. Increasing number of working hours and less comfortable jobs were associated with absenteeism (p for trend 0.06) and impairment of working performance (P for trend .01), as well as gastrointestinal (GI) symptoms both before and after colonoscopy. Occupational and individual characteristics of patients should be considered when programming colonoscopy, as this procedure may impair work productivity in up to one-third of patients. Dose-splitting bowel preparation, performing a painless colonoscopy and preventing the occurrence of GI symptoms may minimize the impact of colonoscopy on work productivity. |
Mean pain was higher on a visual analog scale in the epinephrine group at 30 minutes (47 vs 14; p = 0.022) and at 60 minutes (44 vs 13; p = 0.035). Recovery room stay was longer in the epinephrine group (68 vs 53 minutes; p = 0.034). Epinephrine in the submucosal injectate for EMR increases postprocedural pain, which could cause diagnostic confusion and prolong observation time in the recovery area. |
Tri-modality sampling improves the diagnostic sensitivity for the detection of malignant biliary strictures with no significant difference in sensitivity for CCA compared with pancreatic cancer. However, in patients with PSC, tri-modality sampling was not superior to BC+FISH. |
In 94 external videos, with the assistance of ENDOANGEL-ME, endoscopists showed improved accuracy and sensitivity (85.64% vs 80.32%, 82.03% vs 67.19%). In 194 prospective consecutive patients with 251 lesions, ENDOANGEL-ME achieved a sensitivity of 92.59% (25/27) and an accuracy of 83.67% (210/251) in real clinical practice. The results of the multicenter diagnostic study shows that ENDOANGEL-ME could be well applied in clinical setting. |
Simultaneous EUS-PSG measurement and EUS-guided liver biopsy were both feasible and safe and correlated with clinically evident PH as well as noninvasive markers of fibrosis. |
The use of HDWL and VCE is likely adequate for lesion assessment for prediction of SMIC among LNPCPs. Further, the absence of a DA is strongly predictive for the absence of SMIC, independent to the use of DBC. |
Transesophageal endoscopic resection of mediastinal cysts (with video). Transesophageal endoscopic surgery appears to be a feasible, safe, effective, and much less invasive approach for mediastinal cyst resection. Larger prospective studies are required to fully assess the efficacy and safety of this novel technique. |
| Gut |
Estimating the environmental impact of disposable endoscopic equipment and endoscopes. This quantitative assessment of the environmental impact of endoscopic procedures highlights that a large amount of waste is generated from disposable instruments. Transitioning to single-use endoscopes may reduce reprocessing waste but would increase net waste. |
Our findings uncover that neutrophils induce secondary immunothrombosis by PAD4-dependent mechanisms. Insufficient immunothrombosis may favour rectal bleeding in UC. |
RNA binding protein DDX5 directs tuft cell specification and function to regulate microbial repertoire and disease susceptibility in the intestine. |
| Hepatology |
The digital DBU case-finding algorithm efficiently identified potential HCV treatment candidates, freeing resources for navigation and coordination. The algorithm is portable and accelerated HCV elimination when incorporated in our comprehensive program. |
An ML model based on trichrome-stained liver biopsy slides can predict CSPH in patients with NASH with cirrhosis. |
Lonafarnib, boosted with low dose ritonavir, is a promising all-oral therapy, and maximal efficacy achieved with PEG-IFNα addition. The identified optimal regimens support the first Phase 3 (D-LIVR) study of lonafarnib for the treatment of HDV. |
A short-term increase in alcohol consumption during the COVID-19 pandemic can substantially increase long-term ALD-related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking in the US. |
The poor response of liver cancers to αPD-L1 therapy is largely due to a unique hepatic immunotolerant microenvironment, independent of tumor origins or types. The success of a combinatorial immunotherapy relies on coordinated inhibition or activation of various innate and adaptive immune cell activities. |
Fat-associated Lymphoid Clusters as Expandable Niches for Ectopic Liver Development. The lack of FALCs in the abdominal cavity of immunodeficient tyrosinemic mice hindered the ectopic liver development, whereas the restoration of FALCs formation through bone marrow transplantation restored ectopic liver development in these mice. Accordingly, induced abdominal inflammation increased FALCs numbers, which improved hepatocyte engraftment and accelerated the recovery of tyrosinemic mice from liver failure. In conclusion, abdominal FALCs are essential extra-hepatic sites for hepatocytes engraftment after intraperitoneal transplantation, and as such, represent an easy-to-access and expandable niche for ectopic liver regeneration when adequate growth stimulus is present. |
Compared to non-frail patients, frail LT recipients had a higher risk of post-LT death and greater post-LT healthcare utilization, although overall post-LT survival was acceptable. These data lay the foundation to investigate whether targeting pre-LT frailty will improve post-LT outcomes and reduce resource utilization. |
Introducing Laurie DeLeve, M.D., PhD., our 2022 AASLD President. It is a great honor for me to introduce Dr. Laurie DeLeve as the 2022 President of AASLD. As her former mentor, current colleague, and friend for more than 30 years, it is with enormous pride that I would like to tell you about the background, education, and academic accomplishments of this remarkably talented role model, mentor, and scientific leader of our field. |
This clinical trial showed that independent of weight loss or dietary change, exercise training resulted in a significantly greater decrease in thrombotic risk than standard clinical care in patients with NASH, in parallel with MRI-PDFF reduction and improvement in fitness. Future studies are required to determine if exercise training can directly impact patient outcomes and lower rates of thromboembolism. |
Importantly, compared to GC33 CARTs, there were 5 folds more of 8F8-BBz CARTs in the tumor mass for a longer period of time. Remarkably, the tumor infiltrating 8F8 CARTs were less exhausted and apoptotic, and more functional than GC33 CARTs. The novel low-avidity 8F8-BBz CART resists exhaustion and apoptosis inside tumor lesions, demonstrating a greater therapeutic potential than high-avidity CARTs. |
In conclusion, chronic liver congestion promotes HCC development and liver fibrosis by S1P production from LPS-induced capillarized LSECs. Careful treatment of both RHF and liver cancer might be necessary for RHF patients with primary or metastatic liver cancer. |
FXR plays a pivotal role in regulating iron homeostasis, and protects mice against iron hepatotoxicity. Targeting FXR may represent a therapeutic strategy for iron overload-associated chronic liver diseases. |
The impact of hepatitis B vaccination in United States, 1999-2018. In universal infant vaccination era, HBV vaccine showed substantial effectiveness against HBV infection and maintained strong protection for 20 years. It was also associated with reduced risk of all-cause and cancer-related mortality. |
Interest in anonymous non-directed living organ donation is increasing in the United States and a small number of transplantation centers are accumulating an experience regarding non-directed donation in living donor liver transplantation. Herein we review current transplant policy, discuss emerging data, draw parallels from non-directed kidney donation, and examine relevant considerations in non-directed living liver donation. We aim to provide a consensus guidance to ensure safe evaluation and selection of non-directed living liver donors and a schema for just allocation of non-directed grafts. |
| Inflamm Bowel Dis |
Notably, apoptosis is a vital catabolic process in cells, which is crucial to maintain the stability of intestinal environment and regulate intestinal ecology. In this review, the mechanism of apoptosis induced by reactive oxygen species and endoplasmic reticulum stress, as well as excessive apoptosis in intestinal epithelial dysfunction and gut microbiology imbalance are systematically and comprehensively summarized. Further understanding the role of apoptosis in the pathogenesis of UC may provide a novel strategy for its therapy in clinical practices and the development of new drugs. |
In a large, national sample of adults with IBD, there were strong associations between patients' health confidence and multiple disease outcome measures. Health confidence scores <8 on a 0-10 Likert scale may be clinically useful to screen for patients who are at risk for ED visits and hospitalizations. |
Our findings provide reassurance that the severe acute respiratory syndrome coronavirus 2 vaccine is safe and well tolerated among individuals with IBD, which may help to combat vaccine hesitancy and increase vaccine confidence. |
This study depicts the clinical features and factors associated with behavior progression and surgery among hospitalized CD patients in a Chinese center. Behavior progression is associated with a higher probability of CD-related surgery, and strengthened therapies are necessary for them in the early phase. |
Reducing Pain in Experimental Models of Intestinal Inflammation Affects the Immune Response. There is still a tremendous need to study the underlying pathomechanisms and a well-established tool in order to better understand the disease are colitis models in rodents. Since the concept of the 3Rs was proposed by Russell and Burch, this would include pain medication in animal models of intestinal inflammation as a reduction of suffering. This review argues against pain medication because the administration of pain medication in its current form has an impact on the inflammatory process and the immune response, thus falsifying the results and the reproducibility and therefore leading to misconceptions. |
This work demonstrates that TIPE2 has dual effects in CAC. In the colonocytes, it works as a tumor suppressor. However, in the immune system, TIPE2 may promote tumorigenesis through suppressor cells or inhibit it through IL-22 secretion. Going forward, this work suggests that targeting TIPE2 for CRC therapy requires cell- and pathway-specific approaches and serves as a cautionary tale for immunotherapy approaches in general in terms of colon cancer, as intestinal inflammation can both promote and inhibit cancer. |
Treatment Decision-making in Chinese Inflammatory Bowel Disease Patients. There is a significant difference between ideal and actual decision-making in IBD patients in China. That is, the economy, religiosity, illness severity, and concern about the side effects of treatment are the most important factors affecting treatment decisions in Chinese IBD patients. |
| J Crohns Colitis |
In the largest case series to date, prognosis of patients with GEP-NEN and IBD seems favorable. Incidental NEN diagnosis correlates with an earlier NEN stage and IBD-related therapies are probably independent of NEN stage and grade. The association of GEP-NEN location and the segment affected by IBD may suggest a possible role of inflammation in NEN tumourigenesis. |
Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results. |
Elderly patients with IBD have a similar risk of developing infliximab-related IAEs and LOR to that of younger patients. |
Treatment with either Infliximab or XPro1595 produced moderate protection from ileitis in TNFdARE mice. However, hemizygosity at the TNFR1 locus in TNFdARE mice showed far better protection, implicating TNFR1 signaling as a key mediator of TNF-driven disease. |
A Western dietary pattern was associated with a greater likelihood of CD-development and a carnivorous pattern with UC-development, while a relatively high diet quality (LLDS) was protective for CD-development. Our study strengthens the importance of evaluating dietary patterns to aid prevention of IBD in the general population. |
| J Hepatol |
Simple algorithms based on post-treatment age/albumin/LSM, and optionally, AFP and alcohol, accurately stratified de-novo-HCC-risk in cACLD patients with SVR. Approximately 2/3 were identified as having an HCC-risk <1%/y in both the derivation and validation cohort, thereby clearly falling below the cost-effectiveness threshold for HCC-surveillance. |
These findings identify the Ikaros-SIRT1 axis as a novel mechanistic biomarker of pyroptosis cell death and a putative checkpoint regulator of pro-inflammatory signatures for imposing homeostasis against acute liver injury in mice and humans. |
The fecal mycobiome in non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is one of the most common chronic liver diseases and is associated with changes in the fecal bacterial microbiome. We show that patients with non-alcoholic fatty liver disease and more severe disease stages have a specific composition of fecal fungi and an increased systemic immune response to Candida albicans. In a fecal microbiome-humanized mouse model of Western-diet induced steatohepatitis, we show that treatment with antifungals reduces liver damage. |
Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in al 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed. |
| Neurogastroenterol Motil |
The combined system provides synchronous information about movements and gut contractions. These measurements can be used to extract more information from existing recordings and may enhance our understanding of GI motility in health and disease. |
Adult patients with ASD are more likely to have GERD as well as complications including erosive esophagitis and esophageal ulcer. Treatment of patients with GERD and ASD is not consistent and may suggest health care disparities. |
Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy. |
Whole gut imaging allows quantification of all enteric neurons in the adult zebrafish intestine. Imaging of al enteric neurons within the adult vertebrate intestine is possible in models such as the zebrafish. In this study, we apply this to demonstrate a positive correlation between enteric neuron number and intestinal length. Quantifying total enteric numbers will facilitate future studies of enteric neuropathies and ENS structure in animal models and potentially in biopsied tissue samples. |
Reviews/Editorials
Plenty of the editorials have full text available through the publisher website using the provided link
| Aliment Pharmacol Ther |
| Gastroenterology |
| Gastrointest Endosc |
| Hepatology |
Liver Transplantation for intrahepatic cholangiocarcinoma: ready for prime time? Preliminary single-center reports have described LT in a selected group of patients with locally advanced tumors which have responded to neoadjuvant therapy and have a period of disease stability. Currently, there are three prospective trials underway that will help clarify the role of LT in iCCA. This review seeks to explore the available studies involving LT for iCCA, the challenges of ongoing trials, and opportunities for the future. |
The emoji set curation is overseen by Unicode Consortium, a Silicon Valley based nonprofit which maintains text standards across devices. Our goal, with the support of the AASLD, is to propose the liver emoji to Unicode and ultimately incorporate it into technology globally. The integration of the liver into the Unicode emoji keyboard has the potential to raise the general awareness of the liver's importance and decrease hepatotoxic behaviors. |
| Neurogastroenterol Motil |
Pain in irritable bowel syndrome: Does anything really help? This review article appraises their assessment of the efficacy of the anti-neuropathic agents amitriptyline, pregabalin, gabapentin, and duloxetine in the relief of abdominal pain or discomfort, and impact on overall IBS severity and quality of life. This commentary provides an update of current evidence on the efficacy of the dietary and pharmacological treatments that are available or in development, as well psychological and cognitive behavioral therapy for pain in IBS. Advances in recent years augur well for efficacious treatments that may expand the therapeutic arsenal for pain in IBS. |
Letters&Replies
Letters to the editors and authors’ replies
| Aliment Pharmacol Ther |
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
Financial conflicts of interest (FCOIs) of physicians could bias the tones of recommendations in clinical practice guidelines (CPGs) in the way to benefit commercial entities rather than patients. The US CPGs for hepatitis C by the American Association for the Study of Liver Disease (AASLD) and Infectious Diseases Society of America (IDSA) are known for rigorous control of CPG development, although Jefferson et al reported several discrepancy between the authors' self-reported FCOIs in the CPGs and their articles. |
Letter to the editor: Exacerbation of autoimmune hepatitis after COVID-19 vaccination. We report a case of AIH exacerbation following inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac). The patient is a 57-year-old Asian female without medical history. She developed choluria and acholic stools two weeks after 1st-dose CoronaVac but didn't seek medical advice and received 2nd-dose CoronaVac after three weeks. |
| J Hepatol |
Others
all remaining publications eg case reports, images of the month, etc…
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
| Inflamm Bowel Dis |
| J Hepatol |
